| NPI | 1750498085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 10038) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: PR 10038) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2012-10-03 |