| NPI | 1235368895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX P5453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2012-0484) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2024-05-13 |