| NPI | 1992780597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: ID M-4332) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: MT 4463) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: AZ 17958) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2018-05-29 |