| NPI | 1942512751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 8609351-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 86093511204) |
| 207Q00000X Family Medicine (Licence: UT 86093518904) | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2014-07-30 |