| NPI | 1558793596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX M7972) |
| Additional Taxonomies | 2083B0002X Preventive Medicine Obesity Medicine (Licence: TX M7972) |
| 2083C0008X Preventive Medicine Clinical Informatics (Licence: TX M7972) | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: TX M7972) | |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2019-07-16 |