NPI | 1568545895 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 045076) |
Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: GA 045076) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2007-07-09 |