| NPI | 1144367400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD d0070726) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 1946) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1946) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-07-15 |