| NPI | 1144474826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301093279) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: KY R1737) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: MI 4301093279) | |
| Enumeration Date | 2008-11-08 |
| Last Update Date | 2014-08-10 |