| NPI | 1841759131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A186100) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2024-08-21 |