| NPI | 1619279379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CT 028407) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 028407) |
| 202C00000X Independent Medical Examiner (Licence: CT 028407) | |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2010-12-12 |