| NPI | 1467984146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: LA 338804) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: FL ME143565) |
| 207Q00000X Family Medicine (Licence: LA 338804) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2023-10-16 |