| NPI | 1356385462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NC 2012-01580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 196713) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NC 2012-01580) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2019-07-30 |