| NPI | 1912979014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 38113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G5479) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO 38113) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2023-10-27 |