NPI | 1083295869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: HI 22964) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2021-04-14 |
Last Update Date | 2024-02-27 |