| NPI | 1023108677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2006028597) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: MO 2006028597) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2008-05-30 |