| NPI | 1700976156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 43562-020) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: WI 43562-020) |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2007-07-08 |