| NPI | 1851740500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: CA A152188) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: NC 2023-01941) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2023-12-15 |