| NPI | 1568433795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S9775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 12584) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX s9775) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: HI 12584) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2021-05-11 |