| NPI | 1811980261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: CA G67924) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 24255) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2023-07-10 |