| NPI | 1881199560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 286621) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MA 286621) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-04-10 |