| NPI | 1578561874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 34816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 74479) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CO 34816) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL 74479) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2019-10-29 |