| NPI | 1841682036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G68023) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA G68023) |
| 208D00000X General Practice (Licence: NY 234505-1) | |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2018-02-09 |