NPI | 1598228157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101270185) |
Enumeration Date | 2019-04-10 |
Last Update Date | 2024-03-22 |