| NPI | 1619389988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13846482-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015026063) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MO 2015026063) | |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2024-05-14 |