| NPI | 1427440791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 30743) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MS 24621) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 30743) | |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2022-09-15 |