| NPI | 1710963772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: SD 1559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 1559) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2014-12-02 |