| NPI | 1689651499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 35.138774) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX J8577) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2020-10-16 |