| NPI | 1194166975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PA OS17419) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017419) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2022-06-02 |