| NPI | 1023004868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: UT 187145-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 187145-1205) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: TX K8709) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2015-04-10 |