| NPI | 1760008817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WV 32739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL84513) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2026-05-28 |