| NPI | 1649377169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: ID M14816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A70239) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2020-05-29 |