| NPI | 1760489918 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA 025209 md00025669)  | 
| Enumeration Date | 2005-07-01 | 
| Last Update Date | 2008-03-28 |