| NPI | 1962479881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AZ 43185) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 35057615) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2012-10-19 |