| NPI | 1194075051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D82754) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: VA 0101263719) |
| 207R00000X Internal Medicine (Licence: VA 0101263719) | |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY C5267) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2026-03-13 |