| NPI | 1134369036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: PA MD072693L) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: NJ 25MA04130600) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2011-07-05 |