| NPI | 1316370851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 84968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009121) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2020-08-25 |