| NPI | 1366946931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 75620) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: CT 75620) | |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: CT 75620) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2026-02-26 |