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 |