NPI | 1386344752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: WI 81669-21) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-03-06 |
Last Update Date | 2024-09-24 |