| NPI | 1073960373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 30352) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 30352) |
| 208D00000X General Practice (Licence: NE 30352) | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2022-09-07 |