| NPI | 1972507804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WI 37846) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 31774) |
| 207R00000X Internal Medicine (Licence: MN 39427) | |
| 207R00000X Internal Medicine (Licence: WI 37846) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2018-01-03 |