| NPI | 1568584621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: VT 42-0007395) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |