| NPI | 1356324305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0028599) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL ME28599) |
| 202C00000X Independent Medical Examiner (Licence: FL ME28599) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME28599) | |
| 207Q00000X Family Medicine (Licence: AL 7180) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2010-01-27 |