| NPI | 1699765479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101007112) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 5101007112) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2008-04-07 |