NPI | 1598259046 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205881) |
Additional Taxonomies | 171000000X Military Health Care Provider |
208D00000X General Practice (Licence: VA 0102205881) | |
Enumeration Date | 2018-06-19 |
Last Update Date | 2023-08-03 |