| NPI | 1053516914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OH 34.006699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.006699) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2020-01-14 |