| NPI | 1245677525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MN 82653) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 28112) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2026-08-03 |