| NPI | 1295962603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL ME141572) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2022-01-04 |