| NPI | 1811341456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101273671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 218524) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2022-07-06 |