| NPI | 1942220330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: CA G31910) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G31910) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA G31910) | |
| 208D00000X General Practice (Licence: CA G31910) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-02-26 |