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 | 2024-06-06 |