| NPI | 1255373460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: KS 05-19196) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-19196) |
| 207Q00000X Family Medicine (Licence: MO r1e48) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MO r1e48) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2011-03-31 |