| NPI | 1407940729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101046014) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101046014) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101046014) | |
| 208600000X Surgery (Licence: VA 0101046014) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-07-21 |