| NPI | 1013245372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA 035968) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 035968) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2013-08-08 |