| NPI | 1902938616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: AZ 28814) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MA 55581) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA G67210) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-07-08 |