| NPI | 1427256635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101244536) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8207) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 253655) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2020-10-25 |