| NPI | 1023307139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201301701) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ permit) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2015-09-23 |