| NPI | 1275501041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 48401) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 48401) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WI 48401) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2024-08-15 |