| NPI | 1548255854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101234528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101234528) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-04-14 |