| NPI | 1003378696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: NE 2232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 2232) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-04-01 |