| NPI | 1205290830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: LA 332915) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 332915) |
| 207R00000X Internal Medicine (Licence: LA 332915) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2022-09-13 |