| NPI | 1225017106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX L9183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041799) |
| 207Q00000X Family Medicine (Licence: TX L9183) | |
| 207Q00000X Family Medicine (Licence: FL ME86128) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2021-06-17 |