| NPI | 1992795876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 58914) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: PA MD027109E) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2015-05-12 |