| NPI | 1194726810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR 18724) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR 18724) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OR 18724) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OR 18724) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2011-06-22 |