NPI | 1427049972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 12542) |
Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PR 12542) |
Enumeration Date | 2005-11-03 |
Last Update Date | 2014-02-11 |