| NPI | 1265764377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME43905) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME43905) |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2017-10-26 |