| NPI | 1639178205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4156) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OH 34007355) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX N4156) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: TX N4156) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2014-03-11 |