| NPI | 1245764026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MO 2023013333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS18439) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10060984) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2023-06-21 |