| NPI | 1053380493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101057845) |
| Additional Taxonomies | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: VA 0101057845) |
| 171000000X Military Health Care Provider (Licence: VA 0101057845) | |
| 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: FL ME110242) | |
| 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: MO 2004017086) | |
| 286500000X Military Hospital (Licence: VA 0101057845) | |
| 208D00000X General Practice (Licence: VA 0101057845) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-09-25 |