| NPI | 1003002510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E-8909) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NM A141807) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2020-04-22 |