| NPI | 1588750764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX L3147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L3147) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2011-01-20 |