| NPI | 1720084775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX H5933) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX H5933) |
| 207Q00000X Family Medicine (Licence: TX H5933) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2009-02-19 |