| NPI | 1225176191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD27022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2008-0576) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NM MD2008-0576) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2026-07-09 |