| 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 |