| NPI | 1215361449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102203890) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102203890) |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2026-07-01 |