| NPI | 1932247053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO 50114) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101041297) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2013-08-13 |