| NPI | 1255890216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA MD.61304534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0065235) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0065235) | |
| 208D00000X General Practice (Licence: CO DR.0065235) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2022-07-11 |