| NPI | 1821218140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0101237081) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH pending) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101237081) | |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2019-12-10 |