NPI | 1609850957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MO R3P23) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R3P23) |
Enumeration Date | 2005-11-30 |
Last Update Date | 2023-06-15 |