| NPI | 1508187014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: DE C1-0009960) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C1-0009960) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2025-07-16 |