| NPI | 1538126255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: NC 200500082) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: NC 200500082) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2019-05-13 |