| NPI | 1629450531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX V2513) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.025750) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME149938) | |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MN 36682) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.132288) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2024-09-06 |