| NPI | 1477621134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: IA 02725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 02725) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2015-05-07 |