| NPI | 1245603125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19214) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 19214) |
| 208D00000X General Practice (Licence: PR 19214) | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2022-06-29 |