| NPI | 1215907019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX n5675) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N5675) |
| 207Q00000X Family Medicine (Licence: WI 30120-020) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: WI 30120-020) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX n5675) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WI 30120-020) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2019-10-16 |