| NPI | 1063421279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX H4864) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TX H4864) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-12 |