| NPI | 1487768347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX k2753) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: UT 10955328-1204) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2026-02-25 |