| NPI | 1770711293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL ME108301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME108301) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2023-08-02 |