| NPI | 1962480632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX M0340) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX M0340) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2014-09-02 |