| NPI | 1174617716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 26208) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AL 26208) |
| 207Q00000X Family Medicine (Licence: AL 26208) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-05-11 |