| NPI | 1083603229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: ID M-14730) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01059435A) |
| 207Q00000X Family Medicine (Licence: IN 01059435A) | |
| 207Q00000X Family Medicine (Licence: ID M-14730) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 01059435A) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2019-11-05 |