| NPI | 1932461282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 27494) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 27494) |
| 207Q00000X Family Medicine (Licence: NE 27494) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2025-06-29 |