| NPI | 1780947077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: IL 036142256) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: IN 02005265A) |
| 208D00000X General Practice (Licence: PA OS016859) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.005200) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-04-01 |