| NPI | 1336476639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MN 55885) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 55885) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2022-04-11 |