| NPI | 1508839440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: FL ME131795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 049772) |
| 207R00000X Internal Medicine (Licence: TN MD29487) | |
| 207R00000X Internal Medicine (Licence: AL 28521) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: GA 049772) | |
| 208M00000X Hospitalist (Licence: FL ME131795) | |
| 208M00000X Hospitalist (Licence: TN 29487) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2022-07-11 |