| NPI | 1073572368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: WI 32873-020) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: WI 32873-020) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-11-02 |