NPI | 1720602824 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2023-03119) |
Enumeration Date | 2020-06-04 |
Last Update Date | 2024-04-02 |