| NPI | 1922492487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 29841) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2024-01-29 |