| NPI | 1104260272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 58226) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60657186) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2021-12-29 |