| NPI | 1972035087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WY 15314C) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10959194-1205) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: CO CDRH.0067782) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-09-12 |