| NPI | 1528332426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0102203583) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102203583) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2022-05-10 |