NPI | 1346403144 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60197514) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA OP60197514) |
Enumeration Date | 2008-07-02 |
Last Update Date | 2021-09-22 |