| NPI | 1124142724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: TX E2482) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX E2482) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2017-03-07 |