| NPI | 1073743621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A120844) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ au29035993617) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2021-10-21 |