| NPI | 1730932773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NY 353946) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 353946) |
| Enumeration Date | 2024-04-09 |
| Last Update Date | 2024-04-16 |