NPI | 1699423459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102208361) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2022-03-11 |
Last Update Date | 2025-05-14 |