NPI | 1407441413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: PA OS022372) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2021-03-02 |
Last Update Date | 2023-08-10 |