| NPI | 1932179967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL 85145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 85145) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2022-07-21 |