| NPI | 1871868174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C186770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 53864) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CT 53864) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA C186770) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2024-04-19 |