| NPI | 1598199655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: VA 0101037865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101037865) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2013-08-26 |