| NPI | 1962555052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101242210) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: VA 0101242210) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101242210) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-11-05 |