| NPI | 1528589140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL ME145345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME145345) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL trn25584) | |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2022-06-02 |