| NPI | 1295973766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 55918) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: OH 35092928) | |
| 207R00000X Internal Medicine (Licence: AR E-7928) | |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2016-04-01 |