| NPI | 1184014086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 11021162A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: WA MD61433026) | |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2023-07-24 |