| NPI | 1770163446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WI 81797-21) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.080141) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-06-26 |