NPI | 1841345865 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 01052570A) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01052570A) |
Enumeration Date | 2007-01-23 |
Last Update Date | 2010-01-15 |