| NPI | 1508843301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101223608) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101223608) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2020-06-25 |