| NPI | 1396733192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: MI 4301405356) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MI 4301405356) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2026-02-24 |