| NPI | 1003910720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: TX K8600) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX K8600) |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: TX K8600) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2009-01-12 |