| NPI | 1952311870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME70963) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME70963) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-10-08 |