| NPI | 1902896525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA C54792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C54792) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2019-11-20 |