| NPI | 1376749069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: CA A105928) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA A105928) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2024-05-13 |