| NPI | 1346214277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME100955) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01058007A) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2022-05-26 |