| NPI | 1982236105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0066909) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2025-02-17 |