| NPI | 1114413481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A183419) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 286926) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2023-02-23 |