| NPI | 1912958588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS17664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A14248) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL OS17664) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2024-04-11 |