NPI | 1881042430 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: NE 1782) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 1782) |
Enumeration Date | 2016-05-24 |
Last Update Date | 2022-10-17 |