| NPI | 1255548293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 49163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101245318) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018540) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-05-11 |