| NPI | 1750382503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J2212) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX J2212) |
| 207P00000X Emergency Medicine (Licence: TX J2212) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2019-03-21 |