| NPI | 1164666434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL MD30458) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AL MD30458) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2021-06-07 |