| NPI | 1275897993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301502286) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73467) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2023-04-04 |