| NPI | 1396191565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL ME144766) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME144766) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 4842940) | |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2025-10-02 |