NPI | 1285484337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NV 1285484337) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 1285484337) |
Enumeration Date | 2024-03-22 |
Last Update Date | 2025-05-16 |