NPI | 1952920720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102206746) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102206476) |
Enumeration Date | 2020-04-13 |
Last Update Date | 2023-08-15 |