| NPI | 1972809879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL me108667) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME108667) |
| Enumeration Date | 2011-02-10 |
| Last Update Date | 2023-04-11 |