| NPI | 1023078128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: WY 7777A) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: CA G39841) |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: PA MD427306) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2010-07-01 |