| NPI | 1720041924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OK 20220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 20220) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OK 20220) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-07-29 |