| NPI | 1538431721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: WA MD 00014383) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: WA MD 00014383) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |