| NPI | 1790946911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0101263831) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 53360-20) |
| 171000000X Military Health Care Provider (Licence: WI 53360-20) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101263831) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2022-12-08 |