| NPI | 1720307564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: VA 0101250160) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101250160) |
| 207R00000X Internal Medicine (Licence: VA 0101250160) | |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0101250160) | |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2025-02-13 |