| NPI | 1619403680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 64956) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: CT 64956) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-06-28 |