| NPI | 1154310308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0101049351) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: VA 0101049351) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2007-07-08 |