| NPI | 1730289133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: GA 031374) |
| Additional Taxonomies | 286500000X Military Hospital (Licence: GA 031374) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |