| NPI | 1467773093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: GA 025897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 025897) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 025897) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2010-06-17 |