| NPI | 1619939048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 35391) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO 35391) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2024-01-10 |