| NPI | 1134101264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 5101011920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101011920) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2014-04-22 |