| NPI | 1124406004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-01095) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 211021) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2019-06-11 |