| NPI | 1659900710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MN 73810) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN31278) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2023-10-25 |