| NPI | 1861429722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 22950) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 22950) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2012-12-12 |