| NPI | 1265843726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CO 55576) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: IA DO-05462) |
| Enumeration Date | 2014-05-17 |
| Last Update Date | 2023-03-15 |