| NPI | 1750428587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-050422) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: GA 024775) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MN 23230) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-08 |