NPI | 1003115072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: PA 35-05-6433) |
Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OH 35-05-6433) |
2083S0010X Preventive Medicine, Sports Medicine (Licence: WI 41810-020) | |
Enumeration Date | 2011-03-16 |
Last Update Date | 2011-03-16 |