| NPI | 1710989454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 12704) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PR 12704) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2007-07-08 |