| NPI | 1356537781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: ND 4256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 4256) |
| 207Q00000X Family Medicine (Licence: MN 25160) | |
| 207Q00000X Family Medicine (Licence: AZ 2076) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: MN 25160) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: AZ 2076) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2007-09-19 |