| NPI | 1275811457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01070823A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125055779) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036128601) | |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2022-10-20 |