| NPI | 1235426776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102203372) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102203372) |
| 208000000X Pediatrics (Licence: VA 0102203372) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2023-10-27 |