| NPI | 1164599015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NC 200200290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200200290) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2016-01-22 |