| 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 |