| NPI | 1548799430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: CA A157302) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA A157302) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2023-07-11 |