| NPI | 1679606156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A35819) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD5759) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2011-11-09 |