NPI | 1467926857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102206249) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102206249) |
Enumeration Date | 2019-01-18 |
Last Update Date | 2024-09-17 |