NPI | 1932461282 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 27494) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 27494) |
Enumeration Date | 2012-06-12 |
Last Update Date | 2022-06-29 |