| NPI | 1457515348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: IA 39270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 39270) |
| 207Q00000X Family Medicine (Licence: GA 066631) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-09-18 |