| NPI | 1285861393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-01706) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC 2010-01706) |
| 207Q00000X Family Medicine (Licence: NC 2010-01706) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2025-02-25 |