| NPI | 1043685407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO192476) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG177909) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2019-06-26 |