| NPI | 1710159207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101032335) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0101032335) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |