| NPI | 1518485119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: TX W1823) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX W1823) |
| Enumeration Date | 2017-09-03 |
| Last Update Date | 2025-12-31 |