| NPI | 1588012553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NC 2017-01893) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NE 1680) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2024-05-01 |