| NPI | 1053463646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101008291) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: MI 5101008291) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |