| NPI | 1831351923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: UT 11413672-1204) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-09-23 |