| NPI | 1326494873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0102206885) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102206885) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2024-04-29 |