| NPI | 1689765307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: GA 24744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 24744) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2011-10-03 |