| NPI | 1871537621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H4460) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX H4460) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: TX H4460) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-12-06 |