| NPI | 1659361459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 49455) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MDR-4635) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2022-03-09 |