| NPI | 1033614763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0101267700) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101267700) |
| 208D00000X General Practice (Licence: VA 0101267700) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101267700) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2022-12-05 |