NPI | 1548778715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101267692) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101267692) |
Enumeration Date | 2018-01-22 |
Last Update Date | 2023-09-07 |