NPI | 1003834623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083B0002X Preventive Medicine, Obesity Medicine (Licence: CA A063917) |
Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A63917) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2018-04-24 |