| NPI | 1083813430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX N0716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N0716) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2016-04-14 |