| NPI | 1487610564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 29971) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: AL 29971) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: AL 29971) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2015-11-20 |