| NPI | 1821595083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: AZ 67309) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 1.069602) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-01-09 |