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 |