| NPI | 1467447987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: LA 023971) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: LA 023971) |
| 208D00000X General Practice (Licence: VA 0101262075) | |
| 208D00000X General Practice (Licence: FL ME134984) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2025-06-11 |