| NPI | 1154364024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD09568) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OR MD09568) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OR MD09568) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OR MD09568) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-02-07 |