| NPI | 1821408931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AZ 006745) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 19625) |
| 208D00000X General Practice (Licence: NV SL1008) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-06-17 |