| NPI | 1710910211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: TN 30135) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 30135) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 30135) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2007-08-20 |