| NPI | 1972941169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NV 2021) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0956) |
| 208D00000X General Practice (Licence: AZ 006537) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2024-05-15 |