| NPI | 1669465191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0008353) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OK 2760) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2011-10-20 |