| NPI | 1568438281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NH 9537) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 35042743) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MA 45053) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2007-07-08 |