| NPI | 1336528363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 1586) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 1586) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 1586) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2023-09-26 |