| NPI | 1093985822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MN 63755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 12202) |
| 207Q00000X Family Medicine (Licence: VA 0101242797) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2024-02-28 |