| NPI | 1912135922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS015459) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2014-03-26 |