| NPI | 1184884025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: FL ME131457) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP01309) |
| 208D00000X General Practice (Licence: KY 46346) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2022-07-21 |