| NPI | 1184981391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 69907) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 281634) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2021-10-25 |