| NPI | 1164017901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101275831) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101275831) |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2024-03-20 |