| NPI | 1215991476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: MS 07731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 07731) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2011-03-25 |