| NPI | 1467039743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: CO DR.0068707) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0068707) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-07-10 |