| 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 |