| NPI | 1760425508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: MO R2G63) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: MO R2G63) |
| 2083T0002X Preventive Medicine Medical Toxicology (Licence: MO R2G63) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-07-11 |