NPI | 1093309445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101276925) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101276925) |
171000000X Military Health Care Provider | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-02-25 |
Last Update Date | 2024-05-20 |