| NPI | 1720059066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: SC 10869) |
| Additional Taxonomies | 174400000X Specialist |
| 207Q00000X Family Medicine (Licence: SC 10869) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2015-03-13 |