| NPI | 1548968324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101283122) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0101283122) |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2025-07-22 |