| NPI | 1770689895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 35991) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 35991) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2011-12-13 |