| NPI | 1114160496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: IA R-10278) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-10278) |
| 208600000X Surgery (Licence: IA R-10278) | |
| 208D00000X General Practice (Licence: IA R-10278) | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2015-06-08 |