| NPI | 1275793143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2011-00988) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 148793) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2021-05-11 |