| NPI | 1063478956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: MI 4301078897) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: MI 4301078897) |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: OH 120621) | |
| 207QA0505X Family Medicine Adult Medicine (Licence: MI 4301078897) | |
| 207QA0505X Family Medicine Adult Medicine (Licence: OH 120621) | |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: OH 120621) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2013-12-04 |