| NPI | 1366574055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 15199) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: AL MD.15199) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2022-12-28 |