NPI | 1871295857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102208839) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-03-21 |
Last Update Date | 2025-02-07 |