| NPI | 1568453975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 35.135547) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA MD60476421) |
| 207Q00000X Family Medicine (Licence: WA MD60476421) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2022-04-08 |