| NPI | 1255403218 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MI 4301051265) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301051265) | 
| Enumeration Date | 2006-11-14 | 
| Last Update Date | 2025-09-11 |