| NPI | 1104329770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: DC 0101268047) |
| 208D00000X General Practice (Licence: DC 0101268047) | |
| 261QP0904X Clinic/Center, Public Health, Federal | |
| 208M00000X Hospitalist (Licence: DC 0101268047) | |
| 207Q00000X Family Medicine (Licence: DC 0101268047) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: DC 0101268047) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: DC 0101268047) | |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2025-10-04 |