| NPI | 1447522867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U0813) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA A126457) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2023-03-23 |