| NPI | 1992825582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 39590) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WI 39590) |
| 207Q00000X Family Medicine (Licence: MD D0074982) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2013-05-31 |