| NPI | 1184016073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301111129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01078087A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2022-04-28 |