| NPI | 1407874019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0023888) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NY 218076) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 218076-1) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-04-07 |