| NPI | 1982124384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WV 31528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301112863) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-04-12 |