| NPI | 1235299900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-35629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 2448) |
| 207Q00000X Family Medicine (Licence: NJ 25MB05854600) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: KS 05-35629) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OK 2448) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NJ 25MB05854600) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2022-02-10 |