| NPI | 1205160454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: AZ ARIZONA) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: AZ 4936) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2009-09-21 |