| 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 |