NPI | 1982289542 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: PA OS022393) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA OS022393) |
Enumeration Date | 2021-03-16 |
Last Update Date | 2024-03-26 |