NPI | 1811969306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX T7275) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME153366) |
207Q00000X Family Medicine (Licence: WA MD00045023) | |
207Q00000X Family Medicine (Licence: TX T7275) | |
2083X0100X Preventive Medicine, Occupational Medicine (Licence: FL ME153366) | |
2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX T7275) | |
Enumeration Date | 2006-02-07 |
Last Update Date | 2022-07-08 |