| NPI | 1295141406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 55660) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL MD34607) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2023-08-29 |