| NPI | 1235572983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA 134816) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CA 134816) |
| 208D00000X General Practice (Licence: CA 134816) | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2024-05-01 |