| NPI | 1528034626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AZ 15242) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OH 35-047652) |
| 207Q00000X Family Medicine (Licence: AZ 15242) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 15242) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2016-01-11 |