| NPI | 1225147127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: ID M-7427) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA G55013) |
| 207Q00000X Family Medicine (Licence: ID M-7427) | |
| 207Q00000X Family Medicine (Licence: CA G55013) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |