| NPI | 1275037251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A163892) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA A163892) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2024-02-13 |