| NPI | 1831757186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine Critical Care Medicine (Licence: VA 0101270892) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101270892) |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2024-07-29 |