| NPI | 1972291615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101283948) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 282N00000X) |
| 2865M2000X Military Hospital, Military General Acute Care Hospital | |
| 2865M2000X Military Hospital, Military General Acute Care Hospital (Licence: MD 1720292501) | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2025-05-22 |