| NPI | 1932213071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OH 66034) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 66034) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2012-07-19 |