| 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 |