| NPI | 1194258996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 87895) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 67327) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2021-04-14 |