| NPI | 1851382774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX txpa01512) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX txpa01512) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2026-06-24 |