| NPI | 1497376412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: IN 02006463A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0116034718) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2025-03-19 |