| NPI | 1821369794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MI 4301099709) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301099709) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2017-04-26 |