| NPI | 1356397202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: IA md-25617) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WI 1095) |
| 207Q00000X Family Medicine (Licence: IA 25617) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2021-01-28 |