| NPI | 1558320093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD060878L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 22021) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TN 22021) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TN 22021) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2021-07-13 |