| NPI | 1477544450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME74643) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL AL23646) |
| 207Q00000X Family Medicine (Licence: AL AL23646) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2017-11-24 |