| NPI | 1124094628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PR 11644) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 11644) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PR 11644) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2022-08-31 |