| NPI | 1437136496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101014397) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MI 5101014397) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 5101014397) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2019-02-01 |