| NPI | 1164816229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01077520A) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2023-09-29 |