| NPI | 1386647576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2005-00424) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NC 2005-00424) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OK 20419) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MI 071721) | |
| 208D00000X General Practice (Licence: MI 071721) | |
| 208D00000X General Practice (Licence: OK 20419) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2024-04-26 |