| NPI | 1689653651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200400185) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA C131787) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NC 200400185) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2021-08-10 |