| NPI | 1205362084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX s3492) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-06-16 |