| NPI | 1609969492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX 31647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 6224) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-09-23 |