| NPI | 1760501795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 9129) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NV 9129) |
| 209800000X Legal Medicine (Licence: NV 9129) | |
| 207Q00000X Family Medicine (Licence: CO DR.0056727) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-06-15 |