| NPI | 1457659062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 264574) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101052873) |
| 208D00000X General Practice (Licence: NJ 25MA07921600) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NY 264574) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: VA 0101052873) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NJ 25MA07921600) | |
| Enumeration Date | 2011-03-06 |
| Last Update Date | 2014-08-28 |