| NPI | 1255699278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MN 63255) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: IA 41199) |
| 207R00000X Internal Medicine (Licence: IA R-9371) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2021-08-15 |