| NPI | 1871517201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 35.089731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.089731) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-07-23 |