| NPI | 1194172551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: WY 4245A) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-05-16 |