| NPI | 1306947742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TN MD36551) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TN MD36551) |
| 207Q00000X Family Medicine (Licence: TN MD36551) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-08-02 |