| NPI | 1043730542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A157303) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208M00000X Hospitalist (Licence: GU M-2273) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-02-22 |