| NPI | 1730196080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 112775) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 112775) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MO 112775) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2025-03-14 |