| NPI | 1831206671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 39) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OK 39) |
| 247100000X Radiologic Technologist (Licence: OK 39) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2010-05-13 |