| NPI | 1023093523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PR 7971) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 7971) |
| 207R00000X Internal Medicine (Licence: MD D32409) | |
| 208D00000X General Practice (Licence: NY 161645) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2013-02-08 |