NPI | 1114485000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0102206377) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102206377) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-03-09 |
Last Update Date | 2022-08-16 |