| NPI | 1912468042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OK 37355) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S9125) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-01-10 |