| NPI | 1538786298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: ND 17577) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: ND 17577) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2024-03-28 |