| NPI | 1790014835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 4301104124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.064406) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 35.064406) | |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2024-05-29 |