| NPI | 1942691985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 29399) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 29399) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2026-06-22 |