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 |