| NPI | 1700928082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI 16362) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: NE 22304) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2018-01-15 |