| NPI | 1861488413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 7284305-1204) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: ID 0-319) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2010-09-10 |