| NPI | 1811027758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MS 30535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 44204) |
| 207Q00000X Family Medicine (Licence: NY 250866) | |
| 207Q00000X Family Medicine (Licence: OH 35098218) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2023-08-16 |