| NPI | 1013204999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KS 04-17311) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MO R3J11) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2014-07-09 |