| NPI | 1194392241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: ID O-1734) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 8288488) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2023-07-10 |