NPI | 1619436094 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 2665) |
Additional Taxonomies | 171000000X Military Health Care Provider |
208D00000X General Practice (Licence: NE 2665) | |
Enumeration Date | 2019-03-15 |
Last Update Date | 2022-11-28 |