| NPI | 1942863469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: OH 35.155809) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA 61479190) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2026-07-01 |