| NPI | 1942260997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NM A1170-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM A1170-01) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NM A1170-01) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2010-10-05 |