| NPI | 1346315124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: TX R4995) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101240249) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-04-27 |