NPI | 1083896302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA md011765e) |
Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: PA MD 00165E) |
Enumeration Date | 2007-11-28 |
Last Update Date | 2024-03-22 |