NPI | 1134102437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TX L3011) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA MD00036726) |
Enumeration Date | 2005-11-22 |
Last Update Date | 2007-07-08 |