| NPI | 1477973923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MI 5111021027) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MI 5111021027) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2023-05-19 |