| NPI | 1184610800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 58583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 7725) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: HI 7725) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AZ 58583) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2024-06-05 |