| NPI | 1346485919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C168905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 46491) |
| 207R00000X Internal Medicine (Licence: FL 103915) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2022-03-09 |