| NPI | 1255583332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME67328) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL ME67328) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2009-05-06 |