| NPI | 1235276700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: OR MD25772) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: OR MD25772) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2014-02-04 |