NPI | 1215361449 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102203890) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2013-08-23 |
Last Update Date | 2022-08-02 |