| 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 |