| NPI | 1629058821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-00786) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 02002516A) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2011-06-01 |