NPI | 1023703691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102208821) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-04-10 |
Last Update Date | 2024-07-31 |