| NPI | 1316253685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: HI 18786) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: PA MD040712E) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2020-03-02 |