| NPI | 1649269515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TX H4318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX H4318) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2018-03-27 |