| NPI | 1538780820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102206807) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208M00000X Hospitalist (Licence: VA 0102206807) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2024-05-23 |