| NPI | 1255390191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 23464) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: SC 23464) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NC 9701057) | |
| 208D00000X General Practice (Licence: NC 9701057) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2024-07-16 |