| NPI | 1285672832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NC 38880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 38880) |
| 207Q00000X Family Medicine (Licence: SC 40172) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-03-07 |