| 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 |