| NPI | 1689960171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MO 2012023532) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2012023532) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2024-01-08 |