| NPI | 1649209180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AL 17128) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AL 17128) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: AL 17128) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-03-27 |