| NPI | 1962575944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: CA G32075) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA G32075) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA G32075) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2021-04-02 |