| NPI | 1356713176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19497) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19497) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 13989I) | |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2021-09-02 |