| NPI | 1952373672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102201037) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME DO4002) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2025-01-20 |