| NPI | 1750630117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MT 77926) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102203591) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2019-07-24 |