| NPI | 1811036809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MN 51402) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: CO 57429) |
| 207R00000X Internal Medicine (Licence: NM 2005-0350) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 56538-20) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2018-08-01 |