NPI | 1346535838 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: WI 59999-20) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WI 59999-20) |
207R00000X Internal Medicine (Licence: WI 5999-20) | |
2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: WI 59999-20) | |
261QP2300X Clinic/Center, Primary Care (Licence: WI 59999-20) | |
Enumeration Date | 2011-06-13 |
Last Update Date | 2020-01-28 |