| NPI | 1215298245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL 38952) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 27493) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2023-07-10 |