| NPI | 1013470244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL A194844) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2024-11-20 |