| NPI | 1255782850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 17584) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018031092) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO5031) | |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2021-09-09 |