| NPI | 1730685637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101267597) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2025-02-19 |