| NPI | 1063499028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CO 51167) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MN 28422) |
| 207R00000X Internal Medicine (Licence: CO 51167) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2013-06-24 |