| NPI | 1063539625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WI 77025-21) |
| Additional Taxonomies | 207ZC0006X Pathology, Clinical Pathology (Licence: WI 77025-21) |
| 208D00000X General Practice (Licence: WI 77025-21) | |
| 251K00000X Public Health or Welfare (Licence: WI 77025-21) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-05-20 |