| NPI | 1497774319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G79601) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA G79601) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CA G79601) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-06-09 |