| NPI | 1154461267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: LA 016803) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: LA 16803) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: LA 016803) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2019-12-09 |