| NPI | 1790767424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD 10061) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: HI MD 10061) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2009-07-01 |