| NPI | 1528191616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MD D63287) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-10-28 |