| NPI | 1720191430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 66117) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 22778) |
| 207R00000X Internal Medicine (Licence: WA 61091558) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: AZ 66117) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA 61091558) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 22778) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: AZ 66117) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA 61091558) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NE 22778) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-07-29 |