| NPI | 1316005317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 21940) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 21940) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 21940) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2019-08-14 |