| NPI | 1760759856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: SC DO40625) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV #ED0256A) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2020-10-27 |