| NPI | 1033501044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101021647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TPOS239) |
| 207R00000X Internal Medicine (Licence: TN 4604) | |
| 207R00000X Internal Medicine (Licence: AL DO.2752) | |
| 207R00000X Internal Medicine (Licence: GA 90584) | |
| 207R00000X Internal Medicine (Licence: TX S8970) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2022-08-10 |