| NPI | 1750901211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 34.016149) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.016149) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 34.016149) | |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2023-10-05 |