| NPI | 1982690327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0053813) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MD D0053813) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2012-06-04 |