| NPI | 1730289133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: DC MD210011409) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA 031374) |
| 286500000X Military Hospital (Licence: GA 031374) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-08-20 |