| NPI | 1730150624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA M.D.10207R) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: LA M.D.10207R) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2008-06-26 |