| NPI | 1003378696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: NE 2232) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: NE 2232) | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-06-13 |