| NPI | 1558340570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 26656) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: SC 26656) |
| 208D00000X General Practice (Licence: SC 26656) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2025-07-23 |