| NPI | 1427019421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 17849) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: WV 17849) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2021-11-24 |