| NPI | 1669117339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: PR 1301) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: PR 3103PA) |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2022-04-28 |