| NPI | 1700574902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 345218) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: LA 345218) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2026-08-05 |