NPI | 1053312249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: PA MD-051174-L) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD-051174-L) |
Enumeration Date | 2005-08-10 |
Last Update Date | 2010-02-08 |