| NPI | 1902236128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine Critical Care Medicine (Licence: NC 0010-07072) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005277) |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2024-09-25 |