| NPI | 1760458707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: PA OS007864L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS007664L) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2021-08-17 |