| NPI | 1922457894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME140523) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T5134) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX T5134) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN23392) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-03-10 |