| NPI | 1164879094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014141) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2019-11-14 |