| NPI | 1225561392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD210001430) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A172687) |
| 208000000X Pediatrics (Licence: DC 210001430) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2023-10-30 |