| NPI | 1235295072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WV 18830) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 18830) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2021-04-22 |