| NPI | 1902913114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 31779-020) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: WI 31779-020) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2023-03-07 |