| NPI | 1952389991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: GA 36787) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA 036787) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2020-05-20 |