| NPI | 1043740525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: KY 04934) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101023132) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-06-12 |