NPI | 1225218423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01062083A) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01062083A) |
Enumeration Date | 2007-11-06 |
Last Update Date | 2023-04-20 |