| NPI | 1013288919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MS 07335) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: SC MD 20852) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA 051163) | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2012-01-24 |