| NPI | 1104957190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL OS11893) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS 11893) |
| 207Q00000X Family Medicine (Licence: FL OS 11893) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2022-05-18 |