| NPI | 1659313328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K0722) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX K0722) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX K0722) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX K0722) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2022-08-25 |