| NPI | 1649431537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NE 25420) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 25420) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 25420) | |
| 208D00000X General Practice (Licence: NE 25420) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2022-02-04 |