| NPI | 1700072337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2014-0948) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CO 42385) |
| 208D00000X General Practice (Licence: CO 42385) | |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2025-07-30 |