| NPI | 1881776201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: PR 008209) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 08209) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2019-07-24 |