| NPI | 1003881590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX E6536) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX E6536) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX E6536) | |
| 209800000X Legal Medicine (Licence: TX E6536) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2023-01-27 |