| NPI | 1952713075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101265801) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC 2015-02045) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2023-09-18 |