| NPI | 1568548675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS009118L) |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: VA 0102202355) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2014-09-11 |