| NPI | 1861489635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: SC 16452) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 16452) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2018-11-15 |