| NPI | 1114981164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MD D26656) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D26656) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2007-07-08 |