| NPI | 1912272543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161448) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: FL ME161448) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ZZ 06700926) | |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2024-08-14 |