| NPI | 1578715033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 049579) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CT 49579) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2013-04-17 |