| NPI | 1972641074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TN 42054) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200301189) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MS 20305) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2009-12-04 |