| NPI | 1003127788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.32642) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL MD.32642) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2024-08-06 |