| NPI | 1326053976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL M) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL M) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL M) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2012-02-02 |