| NPI | 1013379619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 62271) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 06-0646844) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2019-07-31 |