| NPI | 1376778696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 124411) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101245226) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0101245226) | |
| Enumeration Date | 2009-05-17 |
| Last Update Date | 2016-04-27 |