| NPI | 1477902047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 30192) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 30192) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2024-05-23 |