| NPI | 1912963885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NJ MA49009) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 205179-1) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 069231) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2011-11-21 |