| NPI | 1407938368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 17244) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MS 17244) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2015-01-29 |