| NPI | 1689126336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 019586) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CT 019586) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2016-10-28 |