| NPI | 1033686704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: OR MD219357) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: UT 12701017-1205) |
| 208D00000X General Practice (Licence: WA MD61191640) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2024-09-30 |