NPI | 1013972884 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: AR C-7091) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NM 91-62) |
Enumeration Date | 2006-04-17 |
Last Update Date | 2011-07-29 |