| NPI | 1831308782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301069704) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 4301069704) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-03-07 |