| NPI | 1306472691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0102206856) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 171000000X Military Health Care Provider (Licence: VA 0102206856) | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2022-11-07 |