| NPI | 1043398456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL 19406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 19406) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AL 19406) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-12-08 |