| NPI | 1891856373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: MD D0035131) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: MD D0035131) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2017-04-04 |