NPI | 1053316042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: NY 230087) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS011858) |
207Q00000X Family Medicine (Licence: ME 1884) | |
207Q00000X Family Medicine (Licence: GA 056306) | |
Enumeration Date | 2005-06-16 |
Last Update Date | 2024-08-16 |