| NPI | 1972846723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PA MD465457) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY R3860) |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2021-03-11 |