| NPI | 1811088230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX G6428) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX G6428) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |