| NPI | 1609204254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS 12894) |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2022-07-13 |