| NPI | 1407148505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R8856) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10039220) |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: TX R8856) | |
| Enumeration Date | 2011-05-07 |
| Last Update Date | 2021-02-23 |