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 |