| NPI | 1942263843 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MI 5101007321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI IG007321) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2018-12-28 |