| NPI | 1609847698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NC 38697) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 38697) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-10-06 |