| NPI | 1164514352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX M7328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22259) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WV 22259) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WI 48476-20) | |
| 207Q00000X Family Medicine (Licence: TX M7328) | |
| 207Q00000X Family Medicine (Licence: WI 48476-020) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-12-09 |