| NPI | 1033598214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND RL13723) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: ND 15268) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2025-06-13 |