NPI | 1417306044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL ME134325) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: FL ME134325) |
Enumeration Date | 2016-06-04 |
Last Update Date | 2024-06-11 |