| NPI | 1821293473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: LA 10776R) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA G166419) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: PA MD450584) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME100120) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2024-01-17 |