| NPI | 1043357452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: MO 2003022490) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2003022490) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MO 2003022490) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2025-08-11 |