| NPI | 1437599719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: WY 12315A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5460) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2023-08-31 |