| NPI | 1508094335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: TX T9873) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME134848) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2023-07-27 |