| NPI | 1710151543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A10663) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00001385) |
| 207Q00000X Family Medicine (Licence: VA 0102202194) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: IL 036-073430) | |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2013-08-07 |