| NPI | 1851334544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: PR 9943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 9943) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2009-03-17 |