| NPI | 1265878797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60816200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 54992) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2018-10-11 |