| NPI | 1831486554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: PA OS016249) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PA OS016249) |
| 208D00000X General Practice (Licence: PA OS016249) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2023-03-25 |