| NPI | 1881097442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A160702) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301106425) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: KY R4135) | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2022-07-21 |