| NPI | 1083728711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX D6035) |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: TX D6035) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-01-28 |