| NPI | 1184812018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NY 253314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 253314) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2025-03-20 |