| NPI | 1972543460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: MO 2013007023) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME 016912) |
| 207R00000X Internal Medicine (Licence: MO 2013007023) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2017-11-08 |