| NPI | 1992717870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 00010897) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AL 00010897) |
| 332900000X Non-Pharmacy Dispensing Site (Licence: AL AR2213344) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2008-07-14 |