| NPI | 1144750522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: GA 114717) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 02006642A) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2026-09-08 |