| NPI | 1457308462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: IA 24456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 24456) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2009-06-10 |