| NPI | 1134656853 |
|---|---|
| Former Name | DERRICK T WALLACE-FERGUSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine Critical Care Medicine (Licence: IN 02007001A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02007001A) |
| 207R00000X Internal Medicine (Licence: MI 5101023275) | |
| 207RP1001X Internal Medicine Pulmonary Disease (Licence: IN 02007001A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2023-10-18 |