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 |