| NPI | 1710959002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS0004500) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL OS4500) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2015-06-09 |