| NPI | 1104117779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA C146100) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA C146100) |
| 261QC1500X Clinic/Center, Community Health (Licence: LA 345860) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2025-05-28 |