| NPI | 1891880829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 25457) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: AZ 25457) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2017-04-15 |