| NPI | 1790800118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7754) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL OS 7754) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: FL 7754) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2017-12-09 |