| NPI | 1164848966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine Critical Care Medicine (Licence: GA 78706) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ZZ 37832) |
| 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: GA 78706) | |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2022-07-21 |