NPI | 1548413362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101245155) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2008-10-23 |
Last Update Date | 2023-08-15 |