| NPI | 1144222118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: TN 18301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 18301) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TN 18301) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2025-09-11 |