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 |