| NPI | 1992934095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MI 5101018319) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101018319) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101018319) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2022-09-06 |