| NPI | 1962494484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX L5019) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L5019) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2018-04-24 |