| NPI | 1740556455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: IL 036152150) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036152150) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 276520) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2021-04-06 |