| NPI | 1407176498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101256097) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207P00000X Emergency Medicine (Licence: MI 4301096499) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301096499) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2022-03-29 |