| NPI | 1497838676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: WI 39656-20) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 39656-20) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2025-05-13 |