| NPI | 1033270848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 688) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 688) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2023-04-28 |