| NPI | 1770018178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IL 036.163369) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207R00000X Internal Medicine (Licence: IL 036.163369) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-02-16 |