| NPI | 1114412251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WV 4576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO6096) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OS16461) | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2025-09-24 |