| NPI | 1902872294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NH 16751) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX H9885) |
| 207Q00000X Family Medicine (Licence: TX H9885) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2021-09-13 |