| NPI | 1861497778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 12378) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NH 12378) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2011-08-23 |