| NPI | 1861804791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101022144) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: MI 5101022144) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2023-07-26 |