NPI | 1083790745 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: CA G59935) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA G59935) |
Enumeration Date | 2006-10-27 |
Last Update Date | 2025-09-11 |