| NPI | 1992707749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MD83226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD048161L) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PA MD048161L) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2020-06-19 |