| NPI | 1962498964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 25135) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: KY 25135) |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: KY 25135) | |
| Enumeration Date | 2005-09-25 |
| Last Update Date | 2014-02-21 |