NPI | 1205589215 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0101279323) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2022-01-31 |
Last Update Date | 2025-01-15 |