| NPI | 1891041273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MO 2021029947) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100551) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100551) | |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2022-02-07 |