| NPI | 1306935010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C30064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX E9907) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA C30064) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX E9907) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |