| NPI | 1225560964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: UT 11483499-1205) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: UT 11483499-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-12-20 |