| NPI | 1417932534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX L4748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L4748) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2020-08-18 |