| NPI | 1407264302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MO 2021015726) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021015726) |
| 367H00000X Anesthesiologist Assistant (Licence: MO 2014030453) | |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2024-06-26 |