| NPI | 1164575544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NM MD2010-0165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX H3332) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX H3332) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NM MD2010-0165) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX H3332) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2021-11-17 |