| NPI | 1679687792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL ME123905) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 275855-1205) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2021-03-16 |