| NPI | 1871569053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: CO DR.0054072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0054072) |
| 207QS0010X Family Medicine Sports Medicine (Licence: CO DR.0054072) | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: CO DR.0054072) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2023-10-17 |