| NPI | 1619263191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 34.010899CTR) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.010899) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2026-01-09 |