| NPI | 1184002610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR PG182916) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR PG178008) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-17 |
| Last Update Date | 2022-07-21 |