NPI | 1922125673 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 12704) |
Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CT 12704) |
Enumeration Date | 2007-03-26 |
Last Update Date | 2011-09-21 |