| NPI | 1114300548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A20772) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS020920) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2024-12-02 |