| NPI | 1588753149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 45530) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G44252) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: CA G44252) | |
| 207R00000X Internal Medicine (Licence: OH 35-053734) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: OH 35-053734) | |
| 207R00000X Internal Medicine (Licence: VA 0101035240) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: VA 0101035240) | |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: MA 45530) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2011-11-14 |