| NPI | 1932550936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A23067) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2024-07-11 |