| NPI | 1669461836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS8411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R2G09) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL OS8411) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MO r2g09) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2023-11-16 |