| NPI | 1255321196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO 40904) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 40904) |
| Enumeration Date | 2005-10-23 |
| Last Update Date | 2015-10-28 |