| NPI | 1063859189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9106) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: TX Q9106) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2021-06-07 |