| NPI | 1528095411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D 5660) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: TX D 5660) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2007-07-08 |