| NPI | 1902008980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX S7034) |
| Additional Taxonomies | 286500000X Military Hospital |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-01-27 |