| NPI | 1497773097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: ND 6205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 34645) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2011-11-30 |