| NPI | 1679562441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0101268314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101268314) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101268314) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2019-12-30 |