| NPI | 1174012603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083B0002X Preventive Medicine, Obesity Medicine (Licence: OH 35.143564) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301505538) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2025-11-25 |