NPI | 1538120498 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00033140) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2006-03-30 |
Last Update Date | 2025-02-12 |