| NPI | 1013238641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1499) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX P1499) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-03-17 |