| NPI | 1518066562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WI 51668-20) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 174400000X Specialist (Licence: PR 13916) | |
| 207R00000X Internal Medicine (Licence: WI 51668-20) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2019-11-19 |