| NPI | 1073101390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0102208710) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102208710) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-03 |
| Last Update Date | 2025-08-06 |