| NPI | 1669441036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: CO 34324) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2018-04-23 |