| NPI | 1083784748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L6405) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX L6405) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2011-03-01 |