| NPI | 1013127224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: PR 9666) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 9666) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |