| NPI | 1700020229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MT 7673) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MT 7673) |
| 208D00000X General Practice (Licence: MT 7673) | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2009-04-28 |