| NPI | 1356734503 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IN 02006583A) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207R00000X Internal Medicine (Licence: FL OS17233) | |
| 207R00000X Internal Medicine (Licence: IN 02006583A) | |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2023-05-08 |