| NPI | 1508842402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101235540) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101235540) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2014-08-24 |