| NPI | 1154617629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 26858) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 26858) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2025-03-11 |