| 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 |