| NPI | 1508841529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-10569) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL 00024831) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2008-09-04 |