| NPI | 1629275227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX J2950) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX J2950) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2007-07-08 |