| NPI | 1689965451 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MO 2019030495) | 
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MO 2019030495) | 
| Enumeration Date | 2011-04-27 | 
| Last Update Date | 2025-09-02 |