| NPI | 1912940347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME 111721) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 34606-020) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-09-29 |