| NPI | 1063831972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A155740) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.34762) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2019-02-12 |