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 |