| NPI | 1538120498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00033140) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2025-02-12 |