| NPI | 1760658397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 75196) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MA 75196) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MA 75196) | |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2021-05-10 |