| NPI | 1376625723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA 150953) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ MA52396) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2023-11-29 |