| NPI | 1255403218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301051265) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: MI 4301051265) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |