NPI | 1619664505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI DOSR-617) |
Enumeration Date | 2023-04-20 |
Last Update Date | 2024-02-20 |