NPI | 1922741768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: CO DR.0072149) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2022-04-19 |
Last Update Date | 2024-01-19 |