| NPI | 1881055994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101263027) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101263027) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2023-08-05 |