| NPI | 1083935829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL OS11393) |
| 208D00000X General Practice (Licence: FL OS11393) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2016-06-20 |