| NPI | 1932112042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13203853-1205) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 13203853-1205) |
| 207Q00000X Family Medicine (Licence: KY 35818) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2025-11-24 |