| NPI | 1780905588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN FA3089225) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2014-10-21 |