| NPI | 1174502090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: WI 42767) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 42767-021) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2018-03-27 |