| NPI | 1285259515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 61551) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY 61551) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2020019001) | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2026-07-03 |