| NPI | 1164895801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS15321) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101025220) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2019-10-11 |