| NPI | 1033686704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: UT 12701017-1205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD61191640) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2022-07-22 |