| NPI | 1629572888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101267945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101267945) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2026-04-24 |