| NPI | 1871681619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CT 031260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 031260) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2025-09-11 |