| NPI | 1427265032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: NY 256704) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: CT 55771) |
| 2083S0010X Preventive Medicine Sports Medicine (Licence: NY 256704) | |
| 2083S0010X Preventive Medicine Sports Medicine (Licence: CT 55771) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: NY 256704) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: CT 55771) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-08-15 |