| NPI | 1669858502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CO 17487) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CO 17487) |
| 207Q00000X Family Medicine (Licence: CO 17487) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO 17487) | |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2015-08-03 |