| NPI | 1144218876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 18944) |
| Additional Taxonomies | 2083T0002X Preventive Medicine, Medical Toxicology (Licence: SC 18944) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: SC 18944) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2013-02-26 |