NPI | 1366861767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101258752) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101258752) |
Enumeration Date | 2014-04-14 |
Last Update Date | 2023-10-02 |