| NPI | 1568759199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX Q9676) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 22610) |
| 208D00000X General Practice (Licence: VA 0101252322) | |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2016-09-14 |