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 |