| NPI | 1306080478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2012-00130) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2012-06-13 |