| NPI | 1265926349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY TP033) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036159885) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 276430) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2026-05-13 |