| NPI | 1699332809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY 62086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL FL1711301) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2026-07-08 |