| NPI | 1386334134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102209001) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2025-02-28 |