| NPI | 1548220072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MN 50158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 36253) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2010-09-27 |