| NPI | 1104816925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 26465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01058040A) |
| 207Q00000X Family Medicine (Licence: KY 26465) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: KY 26465) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2019-05-14 |