| NPI | 1093911885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: KY 03325) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 252015) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NY 252015) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2025-02-24 |