| NPI | 1912015660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX H2962) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX H2962) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2017-07-25 |