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 |