| NPI | 1649244385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: CA G67344) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G67344) |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: CA G67344) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2024-05-03 |