| NPI | 1770775611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX D1083) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX D1083) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: AZ 4988) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PR 3199) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2007-08-14 |