| NPI | 1790766731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VT 032-0000307) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VT 032-0000307) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-08 |