| NPI | 1679218242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX BP10094172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.080389) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2025-06-26 |