NPI | 1316389265 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 138396) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ AU290359926869) |
Enumeration Date | 2013-07-19 |
Last Update Date | 2021-11-02 |