| NPI | 1720103740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 23617) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: AZ 23617) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-11-25 |