| NPI | 1356364921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T9774) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX T9774) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX T9774) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX T9774) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-07-10 |