| NPI | 1255432217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: NE 543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 543) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-08-02 |