| NPI | 1598228157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.49117) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101270185) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-09-23 |