| NPI | 1912264284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 53413) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: KY 53413) |
| 208D00000X General Practice (Licence: GA 73916) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2025-05-04 |