| NPI | 1659437267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MN 64926) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA G 69836) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2019-02-21 |