| NPI | 1841884988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V2045) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX v2045) |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2024-07-30 |