| NPI | 1972575777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.28477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 045109) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: GA 045109) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2008-04-02 |