| NPI | 1699972083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: TX E2128) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: LA MD.012079) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2017-07-14 |