| NPI | 1194073940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MT MED-PHYS-LIC-98200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10493559-1204) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2023-10-24 |