| NPI | 1346745882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO.2694) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 9904) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-09-15 |