| NPI | 1558323543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: SC TL34011) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101235352) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2020-10-08 |