| NPI | 1669854295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NE 1532) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 295339) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-12-09 |