| NPI | 1063486629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 168540-1) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PA MD031587E) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-07-08 |