| NPI | 1689666000 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MD D37382)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D37382)  | 
| Enumeration Date | 2005-08-22 | 
| Last Update Date | 2014-05-15 |