| NPI | 1427468552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL 1551) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: AL 1551) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2024-11-22 |