| NPI | 1790012276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX G4316) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: TX G4316) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2009-11-04 |