| NPI | 1346641438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 21229) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 31,568-R) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2019-05-17 |