| NPI | 1326118555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 455) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: UT 10960787-1204) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-04-26 |