| NPI | 1992799563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 15157) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 15157) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: SC 15157) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2010-05-27 |