NPI | 1548905060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: SC 92613) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2022-04-29 |
Last Update Date | 2025-04-30 |