| NPI | 1659086197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23802) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: PR 16475-I) |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2024-05-07 |