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 |