| NPI | 1164785820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: TX S0075) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX S0075) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2024-01-17 |