| NPI | 1174709109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: HI DOS-1201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-1201) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2022-03-16 |