| NPI | 1669887659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: UT 12406836-1204) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102204300) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2021-09-20 |