| NPI | 1891987905 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NC 2006-01926)  | 
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NC 2006-01926)  | 
| Enumeration Date | 2007-08-13 | 
| Last Update Date | 2007-08-13 |