| NPI | 1093174641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: UT 14167966-1205) |
| Additional Taxonomies | 247200000X Technician, Other |
| 208D00000X General Practice (Licence: MI 4351048467) | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2024-09-27 |