| NPI | 1881661312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 176008-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 176008-1) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NY 176008-1) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2018-05-02 |