| NPI | 1811375520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX BP10085909) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 01077398A) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2023-07-06 |